Editorial

The use of extracorporeal membrane oxygenation (ECMO) in
critical care is growing. From its initial use back in the 1950s in cardiac
surgery, it is now an important tool for life-saving organ support, with clear indications
for use in neonates and growing use in paediatric ICUs. ECMO for adult patients
is also expanding in use (over 400% between 2006 and 2011 in the USA, for example
(Sauer et al. 2015))....

News

The updated definitions and clinical criteria for sepsis
have been welcomed by Professor Jean-Louis Vincent, ICU Management &
Practice’s Editor-in-Chief, who says: “we are finally back to reason – the new
recommendations fit the current language.” The new definitions are published in
the 23 February issue of JAMA, and aim to facilitate earlier recognition and
more timely management of patients with...

Acute respiratory distress syndrome (ARDS) seems to be
underrecognised, under-treated and associated with a high risk of mortality,
according to the results of the ESICM LUNG-SAFE observational study, published
in JAMA. Speaking to ICU Management & Practice, John G. Laffey, MD, MA, of
the Departments of Anesthesia and Critical Care Medicine, Keenan Research
Centre for Biomedical Science, St Michael’s...

The rationale, indications and challenges of extracorporeal lung assist in trauma patients with severe acute respiratory distress syndrome is given on the basis of clinical and scientific experience.Traumatic lung injury is often present in multiple trauma
with a wide spectrum of severity. In a large cohort study, patients with
multiple trauma were reported to suffer from acute hypoxaemia in 64% of...

In-Line Bedside Blood Gas Analysis Enables Rapid Results For
Respiratory Support ManagementExtracorporeal membrane oxygenation (ECMO) is an acute
support system used to aid heart and lung function in patients with severe respiratory
or cardiac failure. Having its origins in the operating theatre, the use of
ECMO has now migrated into the ICU. Since the mortality risk of ICU patients
with ECMO, such...

Since its first clinical use in the 1950s, the set-up and
management of the heart-lung machine (HLM) has been the responsibility of the
perfusionist, who has a documented competency in every facet of extracorporeal technology
because of their theoretical and practical training. In contrast, when this
technology leaves the operating room to provide longer-term support in terms of
ECLS (extracorporeal...

Point-of-View

The Twinstream® ventilator (Carl Reiner GMBH, Vienna,
Austria) is an electricdriven microprocessor-controlled jet ventilator, which
allows simultaneous application of two different jet streams (low frequency and
high frequency), resulting in a pulsatile Bi-Level Ventilation (p-BLV) mode.
ICU Management & Practice spoke to Prof. Dr. Gerfried Zobel about his experiences
with the system in the Paediatric...

Series - Biomarkers

The aim of the present review is to summarise the current
evidence for the use of biomarkers in facilitating therapeutic decision-making
by guiding and tailoring the prescription and the duration of antibiotic
therapy. The main benefits of this strategy are a potential reduction of
antibiotics overuse in critically ill patients.
Overuse of antibiotics and its consequences represent a big
challenge...

Matrix

All drugs are inherently dangerous. In critical care we give
large numbers of particularly dangerous drugs to very sick people, who have
little physiological reserve to cope with additional problems. When patients
are admitted to or transferred out of critical care we have to transfer complex
information about patients’ medications. The staff prescribing and
administering medications are often ine...

This review explores current definitions of frailty, methods
available to diagnose it, and its application to perioperative and critically
ill patients.Frailty is increasingly recognised as a potential
contributor to patient outcome during an episode of critical illness. However,
there is currently no consensus definition or assessment tool. Two main models
exist to conceptualise frailty —the “frailty...

The role of the environment in the transmission of
healthcare-associated infections (HCAIs) is increasingly recognised, requiring
a new approach to the selection of materials for objects frequently touched by
healthcare workers, patients and visitors that can serve as reservoirs of
infection.
There are many technologies and materials on the market, but
none are as effective under typical indoor conditions...

A Roadmap to Rapid Improvements in Patient Safety
This article will provide an overview of how to accelerate
adoption of bedside ultrasonography, based on experience in a large hospital
system. Developing an evidence-based ultrasound training programme and the
economic benefits of proven safety practices, such as ultrasound-guided central
venous catheterisation (CVC), will be addressed.
Every day,...

Intensivists today are faced with a growing deluge of
quantitative data, along with demands to implement evidence-based protocols of
increasing number and complexity. The tools to support such implementation, including
computerised decision support, have, however, seen only incremental development
over the past decades. This article will attempt to provide an analysis of the
underlying causes and suggest...

Management

There has been good
progress in the last decade to ensure that the patient voice is heard at all
levels, including in research and service planning. However there is still more
to be done, and this article sets out the case for meaningful intensive care
patient and relative involvement and how this can be achieved.
Why Involve Former
Intensive Care Patients and Relatives?
The short answer is because...

Nutrition in Critical
Care
Patients in the critical care setting are at risk of malnutrition
(Heyland et al. 2011). The provision of nutrition support (enteral or
parenteral) to critically ill patients is vital, but achieving the optimum
quantity and balance is a contentious topic. There are two major and
contradictory perspectives with respect to how much to feed critically ill
patients. The first...

Knowledge about current research evidence is required by
clinicians in order to practise safe and effective care. The health librarian
occupies a unique position between knowledge resources and knowledge consumers.
As such, the librarian is perfectly poised to channel accurate, reliable knowledge
into the hands of the healthcare team, who can then confidently apply
evidencebased decisions.
Traditionally,...

The significance of research or researchers is frequently
discussed and debated, so also in the medical research field. Why do we
publish? This straightforward question is often difficult to answer, at least
in a simple way. As a starter we can list some reasons:
We wish to make a difference for the outcome of our
patients;
We have an obligation to do research because of unanswered
questions;
We have...

Interview

Todd Dorman takes office as President of the Society of Critical Care
Medicine (SCCM) in February 2016. He is Professor of Anesthesiology and
Critical Care Medicine and Vice Chair for Critical Care Services, Department of
Anesthesiology/Critical Care Medicine; Senior Associate Dean for Education Coordination;
Associate Dean for Continuing Medical Education at Johns Hopkins University
School of Medicine....

The Centre for Research in Intensive Care (CRIC) was
established in 2015 to provide support and services for research into intensive
care, intervention and treatment (CRIC.nu).
CRIC was established to maintain and improve the infrastructure obtained
through the large trials conducted in Denmark, the Scandinavian Starch for
Severe Sepsis/Septic Shock (6S) (Perners et al. 2012) and Transfusion
Requirements...